Atlanta VA Medical Center, Decatur, GA, USA; Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
Lancet Diabetes Endocrinol. 2015 Mar;3(3):173-80. doi: 10.1016/S2213-8587(14)70267-0. Epub 2015 Feb 2.
Programmes for lifestyle change are aimed at improving health but little is known about their effectiveness in clinical settings. The Veterans Health Administration (VA) MOVE! lifestyle change programme is the largest in the USA. We investigated whether participation in MOVE! is associated with reduced incidence of diabetes.
We did a retrospective observational analysis of data from VA databases in overweight patients and obese patients with a weight-related disorder who had undergone at least 3 years of continuous outpatient care in 2005-12. We used generalised estimating equations to assess characteristics associated with MOVE! participation, and Cox's proportional hazards regression to analyse the association between participation and diabetes incidence.
Of 1·8 million eligible individuals, 238 540 (13%) participated in the MOVE! programme. 19 367 (1% overall, 8% of participants) met criteria for intense and sustained participation (at least eight sessions within 6 months over at least a 4-month span), which was associated with greater weight loss at 3 years than low-intensity or no participation (-2·2% vs -0·64% or 0·46%). Compared with non-participation, incidence of diabetes was reduced by intense and sustained participation (hazard ratio 0·67, 95% CI 0·61-0·74) and low-intensity participation (0·80, 0·77-0·83) in MOVE!. These patterns were consistent across sex, ethnic origin, and age. Participation was most beneficial in patients with high BMI or high random glucose concentrations at baseline (both pinteraction<0·0001).
Participation in the MOVE! programme was associated with weight loss and reduced incidence of diabetes, but the rate of participation was low and, therefore, selection bias could have exaggerated these effects.
US Department of Veterans Affairs, National Institutes of Health.
生活方式改变计划旨在改善健康状况，但对于其在临床环境中的有效性知之甚少。退伍军人健康管理局（VA）的 MOVE！生活方式改变计划是美国最大的计划。我们调查了参与 MOVE！是否与降低糖尿病发病率有关。
我们对 2005-12 年间至少连续 3 年接受门诊治疗的超重和肥胖伴有体重相关疾病的退伍军人健康管理局患者数据库中的数据进行了回顾性观察分析。我们使用广义估计方程评估与 MOVE！参与相关的特征，并使用 Cox 比例风险回归分析参与与糖尿病发病率之间的关联。
在符合条件的 180 万人中，有 238540 人（13%）参加了 MOVE！计划。19367 人（总人数的 1%，参与者的 8%）符合高强度和持续参与的标准（在至少 4 个月的时间内，在 6 个月内至少参加 8 次），与低强度或不参与相比，3 年后体重减轻更多（-2.2%比-0.64%或 0.46%）。与不参与相比，高强度和持续参与（危险比 0.67，95%CI 0.61-0.74）和低强度参与（0.80，0.77-0.83）均可降低糖尿病的发病率。这些模式在性别、种族和年龄上都是一致的。在基线时 BMI 较高或随机血糖浓度较高的患者中，参与效果最好（两者的交互作用 p<0.0001）。
参与 MOVE！计划与体重减轻和降低糖尿病发病率有关，但参与率较低，因此选择偏差可能夸大了这些效果。
美国退伍军人事务部，美国国立卫生研究院。
